“I couldn’t pick my daughter up by myself to feed her — helplessness. When I was holding her, feeding her, snuggling her, I didn’t feel that connection any longer. I didn’t feel any differently than when I’d held other people’s babies — guilt. I wound up back in the hospital exactly one week after my daughter was born. I had an infection — defeated. Adrianna could only stay with me if someone else was with me 24/7 — scared.” These are honest words of a new mother who dealt with postpartum depression. The author candidly narrates how she first came to the realization that she was in depression, how she kept her depression a secret because of the stigma associated with postpartum depression. This essay aims to explain biological causes of postpartum depression, explain the issue with representation with regards to postpartum depression as represented in the article and then discuss how maternal leave laws put women more at risk of developing postpartum depression.
Postpartum depression (PPD) is a condition is strictly defined as a mood disorder or major depressive episode that can affect women after childbirth (Sylven, 2012). The disorder begins within the first four weeks after childbirth; however, many women may start noticing symptoms as late as one year after childbirth (Sylven, 2012). Postpartum depression is often confused with postpartum blues that is very common and usually transient condition where mothers feel moody, emotional and anxious (Sylven, 2012). Baby blues usually occur within the between the first 10 days after childbirth and affects 15-85% of women all around the world (Sylven, 2012). Hence, the symptoms of postpartum depression such as depressed mood, loss of interest in normal activities, sleep and appetite disturbances, loss of energy, feelings of guilt, fatigue and irregular weight gain/ weight loss and suicidal thoughts must be present for at least two consecutive weeks (Sylven, 2012).
PPD results from a combination of physical and emotional factors (Mayo Clinic, 2015). After childbirth, the level of hormones (estrogen and progesterone) in a women’s body quickly drop (Mayo Clinic, 2015). This leads to chemical changes in the brain that may trigger mood swings (Mayo Clinic, 2015). In addition, many mothers are unable to get the rest they need to fully recover from giving birth. Constant sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression (Mayo Clinic, 2015). As mentioned before, the symptoms of PPD are listed below;
Five to ten percent of women with PPD present with a high risk of suicide that is an element of postpartum psychosis (Mayo Clinic, 2015). Postpartum psychosis is an extreme case of postpartum depression whose symptoms include, obsessive thoughts about the baby, hallucinations and delusions, paranoia and attempts to harm the baby as well as self (Mayo Clinic, 2015).
With regards to diagnosis of postpartum depression, there are several screening tools such as Edinburgh Postnatal depression scale (EPDS), the Beck Depression Inventory (BDI), the General Health Questionnaire (GHQ), the Patient Health Questionnaire (PHQ), the Bromley Postnatal Depression Scale (BPDS), the Center for Epidemiological Studies Depression Scale (CES-D), the Postpartum Depression Screening Scale (PDSS) and the Zung Self-rating Depression Scale (Zung SDS) that are used for diagnosis purposes (Sylven, 2012). Of these instruments, the EPDS is the most widely used. The optimal time to screen for PPD is two weeks to six months after delivery (Sylven, 2012). Women who screens positive for the condition usually go for a clinical structured psychiatric interview. Depending on the severity of the depression, women opt for supportive sessions with the nurse for mild cases of PPD, cognitive behavioral therapy (CBT), interpersonal therapy (ITP) or psychotherapy for moderate cases; and antidepressant medication for severe cases (Sylven, 2012). In patients who at risk for suicide or development of postpartum psychosis, electroconvulsive therapy (ECT) has been proven to have a rapid impact and the best results (Sylven, 2012). Major challenges with treatment is a) women who take antibiotics cannot breastfeed as it is dangerous for the child b) postpartum depression is often left untreated due to the social stigma around guilt and lastly 3) it is usually really hard to detect major depression because there is often overlap between postpartum blues and depression (Sylven, 2012).
Risk Factor for Postpartum Depression
While it is commonly accepted that postpartum depression can affect any woman regardless of their age, race, nationality and sexuality, recent studies show that there are several risk factors that make it most probable (Sylven, 2012). Previous psychiatric illness is highly associated with PPD and depression in general. A history of somatic illness increases the risk for the disorder. Some studies have shown that women’s age and risk for PPD has some association. Studies show that there is an increased risk of PPD in younger mothers (Sylven, 2012). Social factors such as low socioeconomic status, low level of education, alcohol and drug abuse, low levels of social or partner support, being single and/or unemployed all put women at a greater risk of developing PPD (Sylven, 2012). Additionally, studies also illustrate that violence and abuse (psychological, physical and sexual) also increase the risk for PPD (Sylven, 2012). Obesity is another factor that has been associated with depression and anxiety (Sylven, 2012). Lastly, new research has found a correlation between gender of a baby and PPD (Sylven, 2012). For instance, women given birth in traditional eastern societies are more prone to PPD. In contrast, a recent French study suggests that mothers giving birth to son have an increased risk of developing PPD (Sylven, 2012).
Representations of Postpartum Depression:
This personal narrative perfectly summarizes the issues with representations with regards to postpartum depression. There are two main issues with representation is taboo pertaining to depression and the idea of being the “perfect mother”.
Despite being common, there is still a lot of stigma around postpartum depression. The excerpt details, “I couldn’t pick my daughter up by myself to feed her — helplessness. When I was holding her, feeding her, snuggling her, I didn’t feel that connection any longer. I didn’t feel any differently than when I’d held other people’s babies — guilt”. Guilt is one of the central issues with representation of PPD (Goldstein, 2009). So many women hide their feelings from their family and friends and try to pretend that they are in control of their emotions and their lives (Goldstein, 2009). These women take immense amount of pressure as motherhood is considered one of the most essential and important roles in a woman’s lives. Women deal with anxiety because they feel guilty about the fact that they are not enjoying motherhood (Goldstein, 2009). They feel like something is terribly wrong with them and that they are bad and inadequate mothers since they are not happy being a mother (Goldstein, 2009). Under such circumstances, women often hide their feelings and experiences due to fear of judgment and their own guilt (Goldstein, 2009). This leads to prolonged delay of treatment and exasperates the intensity of the disorder (Goldstein, 2009).
Stigmatization of postpartum depression also stems from the irrational expectation of being a “perfect” mother (Goldstein, 2009). The societal norms have formed far too many expectation with regards to role of a mother. A mother is supposed to unconditionally love her children, never hurt the child, always do what is best for the child, always put the child’s needs before her own, always want to be around the child, should always feel that the most important thing in the world is her child, should always be willing to give up anything for her child, should feel that her child is the only source of her happiness, and the list continues (Goldstein, 2009). This extensive list of expectations are not only irrational and suffocating but also puts a lot of pressure on new mothers which makes it harder for women to seek help (treatment) (Goldstein, 2009). The writer admits in her blog post “I felt like a failure to her. I had one job, to care for my child, and I couldn’t do it. Not without help. I knew there was something “wrong” with me. But who in the world wants to admit that, even to themselves? I just kept thinking that these feelings were normal after childbirth and that millions of women deal with adjusting hormones and major life changes, why couldn’t I? This was just one more thing I was failing at. I was so ashamed to admit what I was going through that I slapped a smile across my face and pretended to be Mary Poppins.” A lot of new mothers are expected to be supermoms as soon as their child is born (Goldstein, 2009). They are supposed to know exactly what to do and are expected to balance taking care of the child and other household chores (Goldstein, 2009). Mothers are not expected to take care of themselves as this violates the “superhero mother” code. Because of such expectations, women feel guilty for not enjoying their motherhood and for not being competent enough to take care of their children (Goldstein, 2009). Hence, they do not seek out care, counseling of treatment facilities (Goldstein, 2009).
Unreasonable maternity leave laws in the US put women at higher risk of developing postpartum depression (Gilpin, 2015). USA is one of the only three countries that does not guarantee paid maternity leave (Gilpin, 2015). The Family and Medical Leave Act (FMLA), implemented in 1993 is the only law that allows qualified employees to take a 12 week of unpaid, job-protected leave for medical leave such as caring for a newborn (Gilpin, 2015). The labour of statistics reports that only 12% of Americans have access to the paid leave which is given as a benefit to employees if the company wishes so (Gilpin, 2015). Only 5% of low-wage earners receive maternity leave compensation. Additionally, this act is not effective as it only covers 59% of US workers (Gilpin, 2015). The 12 weeks of unpaid family leave offered by this program is for women who have worked 1,250 hours per annum (Gilpin, 2015). Due to this requirement, only 2/5 women qualify for the leave (Gilpin, 2015). This increases the risk of postpartum depression primarily because of two main reasons, women are not able to take care of their children and women are not able to financially stabilize themselves (Gilpin, 2015). Research shows that when women do not receive paid maternity leave, they are more likely to drop out of the workforce (Gilpin, 2015). About 43% of women with children leave work voluntarily in order to take care of their children (Gilpin, 2015). On the other hand, women sometimes go back to work too quickly (Gilpin, 2015). About 25% of women go back for work 10 days after having a baby (Gilpin, 2015). Either way, women are at an increased risk of postpartum depression (Gilpin, 2015). When women quit their jobs to sit at home and take care of their children, they loose their financial independence and sense of accomplishments (Gilpin, 2015). This enforces a feeling of helplessness that puts mothers at risk of depression (Gilpin, 2015). When women do go back to work, they give less time to bond with their child (Gilpin, 2015). It also puts more responsibility on their plate as they have to be more in control of their commitments and responsibilities (Gilpin, 2015). This gives women a lot of emotional and physical exertion because of which women develop anxiety and depression (Gilpin, 2015). Therefore, unreasonable maternity leave puts women at higher risk of postpartum depression.
In conclusion, there is still stigma around depression especially postpartum depression despite the recent growth in mental health awareness. A lot of mothers are at risk of developing postpartum depression due to several physical reasons such as obesity, alcoholism, drug abuse, and physical exertion as well as social issues such as lack of support. The underlying reason as to why new mothers develop major depression is because depression often goes undetected and/or mothers are usually do not admit that they have depression. This is usually because of the concept of “supermom” and the taboo nature of depression. The answer to this issue is clear; there needs to be implementation of successful awareness programs that curates this issue. The awareness program needs to focus on abolishing the myth of super moms and endorse the concept of self-care. There are a lot of mothers who make a lot of sacrifices for the good of their children. They put the priorities of their newborn while struggling and need a little bit of self-care; and if they do take rest or practice self-help, they are scorned for it. There needs to be abolishment of the concept of supermom. The new mother need to stop feeling guilty for needing to take care of themselves. Additionally, there needs to be campaigns focusing on reducing the taboo regarding PPD so that mother do not have to hide their depression and live without treatment and care. Thankfully a lot of celebrities have been supporting postpartum depression and are coming forward with their own experience that has empowered new mothers to also take an action and help themselves. Even though it will be a slow process, new mothers will be able to get over their post delivery “hangover” and find a healthy balance between their own lives and motherhood.
Ms Miha Alam
Byrn Mawr College
****The Excerpt called My Shameful Secret by Kaylee Scottaline is retrieved from the link provided below****
Scottaline, Kaylee. "Postpartum Depression: My Shameful Secret." The Huffington Post. TheHuffingtonPost.com, 2013. Web. 5 Dec. 2016.
Goldstein. "POSTPARTUM DEPRESSION (PPD) : SYMPTOMS, CAUSES & TREATMENT." Dr. Robin Goldstein - Boca Raton Psychologist, Depression Counselor, Licensed Therapist for Individuals and Couples. N.p., 2009. Web. 5 Dec. 2016.
Lombino, Elizabeth. "Why Is PostPartum Depression Such a Taboo?" Elizabeth Lombino. N.p., 5 Dec. 2014. Web. 24 Dec. 2015.
"Postpartum Depression." Postpartum Depression Symptoms - Mayo Clinic. Mayo Clinic, 2015. Web. 5 Dec. 2016.
Scottaline, Kaylee. "Postpartum Depression: My Shameful Secret." The Huffington Post. TheHuffingtonPost.com, 2013. Web. 5 Dec. 2016.
Sylvén, Sara M. Biological and Psychosocial Aspects of Postpartum Depression. Uppsala: Acta Universitatis Upsaliensis, 2012. UPPSALA Universitet, 2015. Web.
TechRepublic. "10 Things You Need to Know about Maternity Leave in the US."TechRepublic. N.p., 31 July 2015. Web. 24 Dec. 2016.